Der Anaesthesist
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Review Historical Article
[Nitrous oxide. Trends and current importance].
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Case Reports
[Patient-controlled analgesia. PCA in a three year old child after traumatic amputation].
We report the case of a 3-year-old boy, who received long-term parent-controlled analgesia after traumatic amputation of one leg. He underwent surgery 17 times for a period of 25 days. Parent-controlled analgesia was started four days after admission because analgesia with non-opioid analgetics (acetaminophen) proved to be insufficient. ⋯ Feasibility was shown in adolescents and, more recently, in children aged five years and over. Only few reports are available describing long term use of PCA in children younger than five years. Our case suggests that PCA may also be used effectively and safely in children younger than five years, if experienced staff, a monitoring regimen and cooperative and well instructed parents are available.
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The management of critically ill patients often requires an advanced hemodynamic monitoring. Beside pulmonary artery catheter (PAC) and transesophageal echocardiography (TEE) the transpulmonary indicator dilution technique (TPID) with arterial registration of the indicator dilution curves is a possible approach to get additional hemodynamic information. Being less invasive, measurements of cardiac output by transpulmonary thermodilution are as reliable as the thermodilution using a PAC. ⋯ As with the other methods of advanced hemodynamic monitoring the data available at present do not show a positive effect on the incidence of organ failure and mortality by monitoring critically ill patients with TPID. Before applying an advanced hemodynamic monitoring it should be asked critically which parameter is needed for the therapy-management of the individual patient. Based on this a differentiated monitoring decision has to be made.
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Since its introduction in clinical use more than ten years ago, propofol is well appreciated for sedation and supplemental hypnosis in anaesthesia. However the substance is approved only for anaesthesia in children elder than three years. As can be substantiated by many data reported in literature, there are no pharmacokinetic or pharmacodynamic reasons whatsoever to withhold propofol from the younger children; this applies both to the use as a narcotic supplement and as a short term hypnotic for diagnostic and therapeutic interventions.